Saini Varinder, Lokhande Bhaskar, Jaswal Shivani, Aggarwal Deepak, Garg Kranti, Kaur Jasbinder
Professor, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India.
Junior Resident, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India.
Indian J Tuberc. 2018 Jan;65(1):30-34. doi: 10.1016/j.ijtb.2017.08.001. Epub 2017 Aug 8.
Definitive laboratory diagnosis and confirmation of tuberculosis remains a major challenge because of lack of specificity and sensitivity of diagnostic methods especially in sputum smear negative tuberculosis. Many studies have proved the role of ADA in diagnosis of tuberculosis in effusion fluids and a decrease in ADA activity after treatment. This study was aimed to investigate the role of serum ADA level as an early diagnostic and prognostic marker for pulmonary tuberculosis (PTB).
This was a cohort study done on patients visiting the OPD Clinics of the department of Pulmonary Medicine at GMCH, Chandigarh. 50 sputum positive and 50 sputum negative tuberculosis patients and 100 controls were recruited. Serum ADA levels were measured at the start of treatment and again after two months of treatment. Its correlation with severity of disease was seen.
Mean serum ADA (IU/L) was found to be 35.293±30.941 in PTB patients and 11.819±8.023 in control groups and the difference was found to be highly significant (P<0.00). Mean ADA was 31.107±29.32 in sputum positive patients, 39.478±32.22 in sputum negative and 11.819±8.0235 in control groups. No statistically significant difference was observed amongst sputum positive and sputum negative patients. The levels decreased significantly after intensive phase of treatment. At the cut off values of 14.6IU/L, serum ADA had 78% sensitivity and 76% specificity (AUC=0.801, P value<0.00) to differentiate between PTB from healthy controls.
Serum ADA levels may be used as a biomarker for diagnosis of PTB and to evaluate the response to treatment at follow up.
由于诊断方法缺乏特异性和敏感性，尤其是在痰涂片阴性肺结核中，结核病的明确实验室诊断和确认仍然是一项重大挑战。许多研究已经证明腺苷脱氨酶（ADA）在胸腔积液中结核病诊断中的作用以及治疗后ADA活性的降低。本研究旨在探讨血清ADA水平作为肺结核（PTB）早期诊断和预后标志物的作用。
这是一项队列研究，对象为前往昌迪加尔政府医学院肺科门诊就诊的患者。招募了50例痰涂片阳性和50例痰涂片阴性的肺结核患者以及100名对照者。在治疗开始时和治疗两个月后再次测量血清ADA水平。观察其与疾病严重程度的相关性。
PTB患者的平均血清ADA（IU/L）为35.293±30.941，对照组为11.819±8.023，差异具有高度显著性（P<0.00）。痰涂片阳性患者的平均ADA为31.107±29.32，痰涂片阴性患者为39.478±32.22，对照组为11.819±8.0235。痰涂片阳性和痰涂片阴性患者之间未观察到统计学上的显著差异。治疗强化期后水平显著下降。在截断值为14.6IU/L时，血清ADA区分PTB与健康对照的敏感性为78%，特异性为76%（AUC=0.801，P值<0.00）。
血清ADA水平可作为PTB诊断的生物标志物，并用于评估随访时的治疗反应。
